Abstract
BACKGROUND: In febrile neutropenia (FN), the empirical use of anti-methicillin-resistant Staphylococcus aureus (MRSA) drugs is recommended, particularly when mucosal damage occurs during fluoroquinolone antibiotic administration. Therefore, the early use of anti-MRSA drugs may be recommended in many cases of FN after allogeneic hematopoietic cell transplantation (allo-HCT), but the evidence regarding their efficacy is limited. OBJECTIVES: To assess the impact of early administration of anti-MRSA drugs on the resolution of fever in patients undergoing allo-HCT. METHODS: We retrospectively analyzed 186 allo-HCT patients. Patients receiving anti-MRSA drugs within 3 days of fever onset formed the early-decision group; those treated on or after Day 4 or untreated formed the late-decision group. RESULTS: The early group showed a significantly shorter fever duration than the late group. (p = 0.044). Multivariate logistic regression analysis showed the late group was negatively associated with fever resolution by Day 7 (OR: 0.45, 95% CI: 0.22-0.92, p = 0.028). No significant correlation was observed between anti-MRSA drug timing and acute graft-versus-host disease (aGVHD) in the entire cohort. However, among patients aged 51 or older, the late group showed increased risk of aGVHD (HR: 2.22, 95% CI: 1.06-4.64, p = 0.034). CONCLUSIONS: Associations were observed between the timing of anti-MRSA drug administration and clinical outcomes in allo-HCT, including fever resolution and the incidence of aGVHD in older patients. TRIAL REGISTRATION: The authors have confirmed clinical trial registration is not needed for this submission.